CMS poses a primary obstacle to outpatient spine migration, according to David Essig, MD, of Northwell Health in Great Neck, N.Y.
He told Becker's Spine Review about the biggest roadblocks he sees with outpatient spine surgery.
Note: This response was edited for style.
Question: What billing challenges pose the biggest threat to outpatient spine migration?
Dr. David Essig: Migration to the outpatient surgical space provides unique opportunities in spine surgery. While spine surgeries typically represent around a quarter of orthopedic surgeries, they do represent nearly half the profits in many instances. Some of the challenges with regards to billing will involve the pre-authorization process. However, with some of the updated CMS rules, pre-authorization is not needed for certain codes. Furthermore, CMS has updated their inpatient only list allowing for the migration of more cases to the outpatient centers.
Other challenges involve cost sharing agreements with major carriers. Whether these involve bundled payment agreements or other episodic care agreements will depend upon the strengths and resources of the outpatient centers.